Mhealth
Using low-end technology for high-end gains
“In trying to solve the
public health
challenges of our
time, technology is a
compelling answer...”
Particularly if you’re trying to deliver life-saving
information about maternal and child health to millions of
poor people in the north India
104 million people,
including 27 million women
of child bearing age.
82% of 15-49 year old
men and women in Bihar
have access to a mobile
phone.
63% of men and 32% of
women own their own
phone.
200,000 grassroots
community health workers
in the state.
Each responsible for a
catchment area of 1,000
people.
100% of community health
workers has access to a
phone.
The scale of opportunity is huge...
But there are also huge
challenges to overcome...
80% of people
may have access
to a mobile phone,
but their handsets
look like this....
Old, used,
damaged,
basic....
The majority of
these ‘gray
market’ copycat
handsets do not
support local
language fonts
They don’t own smart phones
The majority can’t read
Even if local language fonts
were supported, the fact
remains that nearly 70% of
women in rural India are
not educated.
They don’t know how to send SMS
The majority of low-
income subscribers in
have owned a mobile
phone for less than a year.
Low literacy and very
recent adoption of mobile
technology mean that
technical literacy is very
low.
91% have never sent an
SMS
All the majority know how
to do is make and receive
phone calls.
They have very little money
A large percentage of rural
population has very limited
disposable income
• Almost 100% are pre-
paid customers
• More than 60% spend
less than USD 1 per month
on telephony
• The average balance is
approximately 10 cents
So how do we design sustainable, effective
mHealth solutions
for millions of people?
mHealth
Too much focus on technology
mHealth
As opposed to people
Technology Centric Design
• Mhealth text services…for largely illiterate
populations
• Algorithm based apps for health workers
on old Nokia phones
• Handset distribution schemes
• Over 100,000 mHealth pilots
• 97% maternal mHealth projects have
failed
Human Centric Design
Human solutions require a confluence of technology and art
Design
• Insight – Understanding people
• Innovation – Making people’s life easier
• Interface – Making the interaction with
technology simpler
mHealth Innovations
• Identify the problem that technology can
solve
• Identify the technology that can solve that
problem
• Design an interface that “works”
Innovations
2 Examples
Mobile Academy
Use IVR technology that is handset
independent, audio based and accessed
via a simple voice call to train Bihar’s
200,000 community health workers to
deliver life-saving information to millions of
families • Mobile Academy is a training course on maternal
and child health
• Covers 33 months - from pregnancy until the child
is 2 years of age
• Designed to expand CHWs’ knowledge of life
saving preventative health and enhance their
communication skills
• Divided into chapters, lessons and quizzes
• Accumulative pass/fail score
• Printed certificate for all those who pass
• Mobile Academy is billed to CHWs at 50 paise per
minute (less than US 1 cent)
• 90% reduction in the standard commercial IVR tariff
• The total cost of taking the course is Rs 80 or $1.50
• This tariff covers the mobile operators’ cost of
delivering Mobile Academy, including government
taxes, and generates revenue
• Operators share revenue with BBC Media action
and its technology platform provider, OnMobile
Global Ltd, to help cover operational costs
• Additional revenue streams including advertising
will make the services commercially attractive in the
longer term
• Strategic partnerships with FMCGs that recognise
that health behaviour change in rural markets will
benefit their products – will enable long term
ownership
& sustainability
Make it cheap, share revenue to cover costs and
create value for advertisers
Equip health workers with an audio
visual job aid that is lightweight and
makes use of the technology they
already own. • Designed to be used by CHWs during their
counselling sessions with families
• Mobile Kunji brings together an IVR-based
mobile service
• And a virtually indestructible deck of 40
illustrated cards on a ring
• Each card communicates life-saving messages
about maternal and child health
• A unique shortcode at the bottom of each card
plays the related audio health message to rural
families
Mobile Kunji
• Designed to be used by CHWs every day, Mobile Kunji is Toll Free
• Exceptionally low rates were agreed with the mobile operators for calls billed to BBC Media Action
• The Government has agreed to cover call costs on an ongoing basis
• Government willing to cover call costs because Mobile Kunji enables high quality, standardized counseling of millions of people, which will save lives and money
Demonstrate value to the public sector
Develop partnerships for scale
• BBC Media Action launched Mobile Kunji and Academy in
Bihar in May 2012
• A partnership with six of the biggest mobile operators in India,
accounting for 90% of the market in Bihar: Airtel, BSNL, Idea,
Reliance, TATA and Vodafone
• Leverages an existing, proven mobile technology platform
provided by OnMobile Global Ltd, integrated with the
networks of all participating operators not just in Bihar – but
pan India
• Means the services can be used on any handset, and are
available on common shortcodes and common tariffs
across all participating operators
• Developed with funding from the Bill & Melinda Gates
Foundation and with the support of the Government of Bihar
– as part of the Ananya Programme
•
Prove demand and scale
• 85,000 people have begun using Mobile Kunji during the last 10 months, playing 2.3 million minutes of life-saving health content via their mobile phones
• 27,000 people have begun the Mobile Academy training course, accessing 2.8 million minutes of health education content via their mobile phones. More than 8,000 have already completed the course.
• They are now being scaled to the state of Odisha, with funding from the UK Department for International Development and with the support of the Government of Odisha
• We are in discussion with the central Indian government to scale the services to all the north Indian states, including Utter Pradesh, which has a population of 200 million people